Satoshi Yokoyama, MD, Daisuke Ito, Akinori Sekioka, Nao Kawaguchi, Harumi Yamada, Michio Kuwahara, Hirofumi Utsunomiya, Shiro Uyama
Department of Surgery, Japanese Red Cross Society, Wakayama Medical Center, Wakayama, Japan (all authors).
Introduction: Portomesenteric venous thrombosis (PMVT) is a rare and often fatal disease that is difficult to diagnose. The symptoms are nonspecific, and diagnosis and initial treatment tend to be delayed. The initial treatment strategy for PMVT has recently tended toward the use of conservative methods before surgical intervention, and most patients can be successfully treated in this way. In rare cases, however, bowel strictures may develop, owing to chronic ischemia.
Case Description: We present a case of elective laparoscopy-assisted small-bowel resection of ischemic jejunal stenosis following extensive portal, mesenteric, and splenic vein thrombosis.
Discussion: Laparoscopy is indicated for this condition because of the possible need for repeated operations and extensive intraoperative exploration. However, laparoscopy with pneumoperitoneum can be a risk factor for recurrent PMVT, indicating the need to develop methods to shorten the operation time.
Key Words: Delayed bowel strictures, Laparoscopic surgery, Pneumoperitoneum, Portomesenteric venous thrombosis.